Roughly 70 percent of adults facing unaffordable out-of-network medical bills believed their healthcare provider was in-network when they received care, according to the Kaiser Family Foundation.
These bills are often the result of balancing billing, which occurs when providers bill patients for outstanding medical balances after a payer satisfies its portion of the bill. If the provider is out-of-network with the insurer, the provider can bill the patient any remaining balances. Ed Gaines, chief compliance officer of Zotec Partners, a Carmel, Ind.-based revenue cycle management service company, spoke about how providers can reduce balance billing at the Becker's Hospital Review 3rd Annual Health IT + Revenue Cycle Conference in Chicago.
Here are three takeaways about balance billing and physicians' role in addressing the practice, according to Mr. Gaines.
1. The balancing billing conundrum often involves bad data and insurers branding balance billing as "surprise billing" from the provider, Mr. Gaines said. At the same time, the number of Americans age 18 to 64 with a high-deductible health plan grew from 26.3 percent in 2011 to 39.3 percent in 2016, according to a report from the CDC's National Center for Health Statistics. As patients have a harder time meeting their deductible, Mr. Gaines said balance billing has become more poignant today than it was 10 or 15 years ago.
2. Providers and national organizations like the American Medical Association banded during the last three or four years to address balance billing. In doing so, "physicians are the ones who are leading the charge to propose solutions," Mr. Gaines said. He pointed to Physicians for Fair Coverage, a multispecialty alliance of physician groups advocating to improve patient protections when it comes to balance billing, and a joint task force developed by the American College of Emergency Physicians and Emergency Department Practice Management Association. The joint task force develops solutions and recommendations for out-of-network and balance billing challenges to both organizations' members.
3. Mr. Gaines offered the following strategies for providers looking to address the out-of-network and balance billing conundrum:
- Build a multispecialty coalition with consumer groups
- Devise and send out media campaigns
- Write letters to the editor aimed at removing the patient from the middle of the dispute
- Access sources like FAIR Health for benchmarking out-of-network physician rates